What Is the Part of Tropical Diseases Among Infectious Complications in Renal Transplant Recipients in the Amazon? A 12-Year Multicenter Retrospective Analysis in French Guiana.

BACKGROUND: Infectious complications in kidney transplant recipients (KTRs) are well studied in temperate countries but remain barely known in tropical ones. The main objective of this study was to describe infection-related hospitalizations in patients living in the Amazon, where it has never been described. METHODS: All KTRs residing in French Guiana between 2007 and 2018 were included retrospectively. Infection-related hospitalizations were collected in the main medical centers of the territory. RESULTS: Eighty-two patients were included, and 42 were infected during the study period (51%). Eighty-seven infections were identified. The main sites of infection were urinary, in 29% of cases (25/87), and pulmonary, in 22% of cases (19/87). When documented (48/87), bacterial infections were predominant (35/48), followed by viral (8/48), fungal (4/48), and parasitic infections (1/48). Endemic so-called tropical infections accounted for 6% of infections (5/87). Histoplasma capsulatum was the most commonly isolated fungus (2/4). CONCLUSIONS: This study suggests that the spectrum of infections in KTRs in French Guiana differs little from that of temperate countries. Nevertheless, some tropical infections are described. More studies on fungal infections in KTRs should be undertaken to clarify the weight of histoplasmosis in these patients.

Sudden Death Due to Neck Paraganglioma: A Pediatric Case Report and Review of the Literature.

Neck paragangliomas are relatively rare neuroendocrine nonsecretory tumors. They are mainly observed among adults and are often asymptomatic, causing a frequent delay in diagnosis. In pediatric cases, neck paragangliomas can be associated with adrenergic symptoms that may lead to complications.A report of a sudden death due to a carotid paraganglioma in a young girl is reported. Autopsy revealed a thoracic arotic dissection and a 4-cm jugulocarotidian mass in the absence of traumatic injuries. Histology showed no evidence of underlying aortic disease, including signs of Marfan syndrome, and a paraganglioma. Postmortem biochemistry analysis showed blood metanephrines levels 100 times higher than normal range. The cause of death was an aortic dissection complicating a neck paraganglioma. The manner of death was concluded as natural.Our case highlighted the importance for forensic pathologist to consider the diagnosis of paraganglioma in case of sudden hypertensive complications, especially among young people.

A comparative study of bypass versus percutaneous intervention for left main disease.

INTRODUCTION: Left main coronary artery disease is known as the highest risk lesion subset of ischemic heart disease. Several studies have shown a significant benefit following treatment with coronary artery bypass grafting compared with medical treatment. As a result, surgery has been the standard of care for the revascularization of left main disease for a long time. However, with the remarkable improvements in interventional cardiology, percutaneous coronary intervention has become technically feasible and showed favorable clinical outcomes. AIM: We sought to evaluate trends in treatment strategies of left main coronary artery disease over time in Sahloul University Hospital and to compare patient's characteristics as well as early, mid-term and long-term adverse outcomes of each therapeutic option. METHODS: From 2005 to 2016, 260 patients with unprotected left main disease (defined as stenosis of at least 50%) were included. 109 patients underwent PCI (group 1), 102 patients underwent Surgery (group 2) and 49 patients were medically treated (group 3). Major cardiac and cerebrovascular events were defined as the composite of: mortality, nonfatal myocardial infarction, stroke, and need for repeat revascularization. Event rates were estimated with Kaplan-Meier analyses. RESULTS: Over time, the proportion of patients treated with percutaneous coronary intervention rather than coronary artery bypass grafting increased substantially, whereas the proportion of patients who received medical therapy remained steady. Group 1 patients had more cardiogenic shock (6.4% vs 0%, p=0,01) at presentation compared to group 2. More patients treated with surgery had multivessel disease (73% vs 40%; p <0.001), more distal left main bifurcation lesions (52.3% vs 73.5%; p=0.001) and higher SYNTAX scores (23.3±9.96 vs 32.5±8.7; p <0.001). All the other baseline variables were similar. At follow up, there were no differences, at the adjusted analysis, in the rate of myocardial infarction, cerebrovascular accidents, and the composite endpoint of major cardiovascular and cerebrovascular events (HR: 1, 04; 95% CI: 0.59 to 1.83; p=0.88). Compared to percutaneous coronary intervention group, group 2 has a higher all-cause mortality (p=0.017) driven exclusively by an elevated incidence of operative mortality (13.7% vs. 6.4%; HR: 0.08; 95% CI: 0.017 to 0.43; p=0.003). Nevertheless, long-term advantage of coronary artery bypass grafting over percutaneous coronary intervention was the less need for repeat revascularization (HR: 3.1; 95% CI: 1.26 to 8.12; p=0.014). CONCLUSION: Our data show that revascularization therapy have evolved remarkably in the favor of percutaneous coronary intervention over the last decade. Angioplasty and coronary artery bypass graft show comparable safety. However, the need for revascularization is more common after percutaneous treatment.

End stage renal disease in French Guiana (data from R.E.I.N registry): South American or French?

BACKGROUND: End-Stage renal disease (ESRD) causes considerable morbidity and mortality, and significantly alters patients' quality of life. There are very few published data on this problem in the French Overseas territories. The development of a registry on end stage renal disease in French Guiana in 2011 allowed to describe the magnitude of this problem in the region for the first time. METHODS: Using data from the French Renal Epidemiology and Information Network registry (R.E.I.N). Descriptive statistics on quantitative and qualitative variables in the registry were performed on prevalent cases and incident cases in 2011, 2012 and 2013. RESULTS: French Guiana has one of the highest ESRD prevalence and incidence in France. The two main causes of ESRD were hypertensive and diabetic nephropathies. The French Guianese population had a different demographic profile (younger, more women, more migrants) than in mainland France. Most patients had at least one comorbidity, predominantly (95.3%) hypertension. In French Guiana dialysis was initiated in emergency for 71.3% of patients versus 33% in France (p < 0.001). CONCLUSION: These first results give important public health information: i) End stage renal disease has a very high prevalence relative to mainland France ii) Patients have a different demographic profile and enter care late in the course of their renal disease. These data are closer to what is observed in the Caribbean or in Latin America than in Mainland France.

[High prevalence of proteinuric nephropathy screened in patients with type 2 diabetes consulting community-based general practitioners in French overseas departments and territories. ALBUM study]. / Prévalence elevée de la protéinurie dépistée en médecine générale chez les patients diabétiques de type 2 dans les DOM-TOM. Etude ALBUM.

UNLABELLED: OBJECTIVE, METHOD: Chronic kidney disease is a major public health problem. This observational epidemiological study aimed to evaluate the prevalence of proteinuric nephropathy in patients with type 2 diabetes consulting a community-based general practitioner in French overseas departments and territories (DOM-TOM). Screening was carried out with reagent strips Albustix for proteinuria and, in case of trace amounts or a negative result, Microalbustix for microalbuminuria. RESULTS: 91 general practitioners participated in the study with 402 evaluable patients (54% female, mean age 60.1 +/- 11.2 years). The duration of diabetes was 8.9 +/- 6.6 years and mean HbA1c was 7.3 +/- 1.4% (52.2% with HbA1c < or = 7%). Screening was positive for 45.7% of the patients: 23.6% positive for proteinuria with Albustix [95% CI: 19.5-27.8] and 22.1% with Microalbustix. CONCLUSION: Screening with reagent strips revealed that nearly half the patients had proteinuria or albuminuria, thus confirming the high prevalence of nephropathy in type 2 diabetes patients living in the Dom-Tom and illustrating the need for frequent renal function screening in type 2 diabetics in general medicine for the prevention of chronic kidney disease.